Prophylactic Versus Endoscopy-driven Treatment of Crohn’s Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study]-Reference-Cited by-同舟云学术

Prophylactic Versus Endoscopy-driven Treatment of Crohn’s Postoperative Recurrence: A Retrospective, Multicentric, European Study [PORCSE Study]

Published:2024-01-19 Issue:8 Volume:18 Page:1202-1214
ISSN:1873-9946
Container-title:Journal of Crohn's and Colitis
language:en
Short-container-title:

Author:

Geldof Jeroen¹^ORCID,Truyens Marie¹,Hanssens Michiel¹,Van Gucht Emily¹,Holvoet Tom²,Elorza Ainara³,Bouillon Vincent⁴,Barros Sónia⁵,Martins Viviana⁵,Argyriou Konstantinos⁶,Potamianos Spyridon⁶,Diculescu Mircea⁷,Stroie Tudor⁷,Bossuyt Peter⁸^ORCID,Moens Annick⁸,Theodoraki Eirini⁹,Koutroubakis Ioannis E⁹,Pedro Juliana¹⁰,Fernandes Samuel¹⁰,Nikolaou Pinelopi¹¹,Karmiris Konstantinos¹¹,Baert Filip J¹²,Ferreiro-Iglesias Rocio¹³^ORCID,Peeters Harald¹⁴,Claeys Sophie¹⁴,Casanova Maria José¹⁵,Eder Piotr¹⁶,Porter Ross J¹⁷,Arnott Ian¹⁷,Karakan Tarkan¹⁸,Mesonero Francisco¹⁹^ORCID,Revés Joana²⁰,Van Dyck Evi²¹,Jauregui-Amezaga Aranzazu²²,Mañosa Míriam²³,Rivière Pauline²⁴^ORCID,Marquez Mosquera Lucia²⁵,Portela Francisco²⁶,Pimentel Raquel²⁶,Lobaton Triana¹^ORCID

Affiliation:

1. Department of Gastroenterology and Hepatology, University Hospital Ghent , Ghent , Belgium

2. Department of Gastroenterology and Hepatology, VITAZ , Sint-Niklaas , Belgium

3. Department of Gastroenterology, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute , Vizcaya , Spain

4. Department of Gastroenterology, Erasme University Hospital , Brussels , Belgium

5. Department of Gastroenterology – Algarve Universitary Medical Center , Lisbon , Portugal

6. University Hospital of Larissa - IBD unit, Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly , Larisa , Greece

7. Gastroenterology and Hepatology Center Fundeni Clinical Institute, Carol Davila University of Medicine Bucharest , Bucharest , Romania

8. Imelda GI Clinical Research Center, Department of Gastroenterology, Imelda General Hospital , Bonheiden , Belgium

9. Department of Gastroenterology, University Hospital Heraklion , Heraklion , Greece

10. Department of Gastroenterology and Hepatology, Hospital Santa Maria, Centro Hospital Universitario de Liboa Norte , Lisbon , Portugal

11. Department of Gastroenterology, Venizeleio General Hospital , Heraklion , Greece

12. Department of Gastroenterology, AZ Delta , Roeselare , Belgium

13. Inflammatory Bowel Diseases Unit, Department of Gastroenterology, Hospital Clinico Universitario de Santiago, Fundación Instituto de investigación Sanitaria de Santiago de Compostela, Santiago de Compostela , Spain

14. Department of Gastroenterology, AZ Sint-Lucas , Ghent , Belgium

15. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa [IIS-Princesa], Universidad Autónoma de Madrid [UAM], Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas [CIBEREHD] , Madrid , Spain

16. Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences , Poznan , Poland

17. Edinburgh IBD unit, Western General Hospital , Edinburgh , UK

18. Department of Gastroenterology, Gazi University , Ankara , Turkey

19. Department of Gastroenterology and Hepatology, Hospital Universitario Ramon y Cajal , Madrid , Spain

20. Department of Gastroenterology, Hospital Beatriz Ângelo , Loures , Portugal

21. Department of Gastroenterology, AZ Klina , Brasschaat , Belgium

22. Department of Gastroenterology and Hepatology, University Hospital Antwerp, Laboratory of Experimental Medicine and Pediatrics [LEMP], University of Antwerp , Antwerp , Belgium

23. Centro de Investigacion Biomédica en Red de Enfermedades Hepaticas y Digestivas, Hospital Department of Gastroenterology and Hepatology, Universitario Germans Trias i Pujol , Barcelona , Spain

24. Department of Hepato-Gastroenterology and Digestive Oncology, CHU Bordeaux, Hôpital Haut Levêque , Bordeaux , France

25. IBD unit, Hospital del Mar , Barcelona , Spain

26. Department of Gastroenterology, Hospital and University of Coimbra , Coimbra , Portugal

Abstract

Abstract Background and Aims No consensus exists on optimal strategy to prevent postoperative recurrence [POR] after ileocaecal resection [ICR] for Crohn’s disease [CD]. We compared early medical prophylaxis versus expectant management with treatment driven by findings at elective endoscopy 6–12 months after ICR. Methods A retrospective, multicentric, observational study was performed. CD patients undergoing first ICR were assigned to Cohort 1 if a biologic or immunomodulator was [re]started prophylactically after ICR, or to Cohort 2 if no postoperative prophylaxis was given and treatment was started as reaction to elective endoscopic findings. Primary endpoint was rate of endoscopic POR [Rutgeerts >i1]. Secondary endpoints were severe endoscopic POR [Rutgeerts i3/i4], clinical POR, surgical POR, and treatment burden during follow-up. Results Of 346 included patients, 47.4% received prophylactic postoperative treatment [proactive/Cohort 1] and 52.6% did not [reactive/Cohort 2]. Endoscopic POR [Rutgeerts >i1] rate was significantly higher in Cohort 2 [41.5% vs 53.8%, OR 1.81, p = 0.039] at endoscopy 6–12 months after surgery. No significant difference in severe endoscopic POR was found [OR 1.29, p = 0.517]. Cohort 2 had significantly higher clinical POR rates [17.7% vs 35.7%, OR 3.05, p = 0.002] and numerically higher surgical recurrence rates [6.7% vs 13.2%, OR 2.59, p = 0.051]. Cox proportional hazards regression analysis showed no significant difference in time to surgical POR of proactive versus expectant/reactive approach [HR 2.50, p = 0.057]. Quasi-Poisson regression revealed a significantly lower treatment burden for immunomodulator use in Cohort 2 [mean ratio 0.53, p = 0.002], but no difference in burden of biologics or combination treatment. Conclusions The PORCSE study showed lower rates of endoscopic POR with early postoperative medical treatment compared with expectant management after first ileocaecal resection for Crohn’s disease.

Publisher

Oxford University Press (OUP)

Link

https://academic.oup.com/ecco-jcc/advance-article-pdf/doi/10.1093/ecco-jcc/jjae011/56594583/jjae011.pdf

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